胸腹部常见肿瘤骨转移的临床特征与预后因素分析
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摘要
目的研究肝细胞癌(下称肝癌)、前列腺癌、非小细胞肺癌(下称肺癌)、肾细胞癌、胃腺癌、乳腺癌、直肠腺癌骨转移患者的临床特征及其相关的预后因素。方法收集自1997年至2007年共10年间,在本科接受外照射治疗的肝癌骨转移患者共205例。在接受放射治疗之前了解这些患者一般信息、实验室指标、肿瘤特点(原发灶及骨转移灶)以及以往的治疗形式,放疗剂量范围为32～66Gy,中位剂量50Gy,放射区为转移累及骨。对患者的性别、Karnofsky评分、肝功能状况(Child-Pugh分级)、乙肝表面抗原、肝内原发灶的大小、数目、控制情况、骨转移时AFP的水平、r-GT的水平、ALT水平、AST水平、ALP水平、血红蛋白、白细胞计数、血小板计数、总胆红素、白蛋白、白/球比率以及骨转移灶的数目、骨转移时是否伴有骨旁软组织和其他脏器转移、是否行肝移植术等多项因素进行分析。
收集本院1997～2007年间诊治的前列腺癌骨转移患者115例、非小细胞肺癌骨转移患者148例、肾细胞癌骨转移患者45例、胃腺癌骨转移患者38例、乳腺癌骨转移患者46例及直肠腺癌骨转移患者32例,收集其临床病史影像学及病理学检查资料、血液指标及治疗方法等。
上述病例均随访至2007年12月31日,均进行回顾性分析。
用SPSS15.0在Windows XP下进行单因素和多因素分析,生存率用Kaplan-Meier法计算,单因素分析用Log-rank方法,多因素分析采用Cox回归模型。
结果肝癌骨转移患者1、2、3年生存率分别为32.4%、13.2%、8.5%,中位生存期7.4个月。205名肝癌骨转移患者的特征是溶骨性破坏为主,伴有成骨成分,有80例(39%)骨转移灶周围伴有软组织肿块者。在照射剂量32～66Gy的患者中,我们并没有发现骨转移症状的减轻与剂量有明显关系,其剂量与效应之间并不呈正相关。不过骨转移灶周围伴有软组织肿块者的患者再治疗率相对比较高。通过单因素分析,我们发现较短的生存率和以下几方面有关:较低的Karnofsky评分、低白蛋白水平、较高的骨转移时ALP、r-GT和AFP水平、肝内肿瘤大于5cm、肝内原发灶未控、多发骨转移灶、累及脊椎、骨外其他脏器转移以及诊断肝癌至出现骨转移的时间较短。在多因素分析中,较低的Karnofsky评分、骨转移时较高的AFP水平、AST水平、血小板计数、肝内原发灶未控制、前5年的治疗诸因素均为独立预后因子(P值均＜0.05),与预后有关。
前列腺癌骨转移生存率,1年为89.1%,2年76.9%,3年60.9%,5年49.8%,中位生存期48.5个月。其单因素分析显示患者年龄、原发灶Gleason评分、初诊时临床分期、骨转移灶数目、发生骨转移时ALP水平、是否伴有非区域淋巴结转移、是否伴有其他脏器转移诸因素对预后有影响。其Cox多因素分析显示骨转移灶数目、骨转移时ALP水平、诊断原发灶时Gleason评分、年龄、非区域淋巴结转移诸因素对预后有影响。
肺癌骨转移患者生存率,1年为52.2%,2年26.5%,3年21.2%,5年3.7%,中位生存期13个月。其单因素分析显示骨转移灶数目、骨转移时ALP水平、骨转移时是否伴有其他脏器转移诸因素对预后有影响。其Cox多因素分析显示初诊时临床分期、骨转移时ALP水平、是否伴其他脏器转移及骨转移灶数目诸因素对预后有影响。
肾癌患者出现骨转移后其生存率明显下降,其骨转移患者生存率,1年为54.0%,2年26.0%,3年17.3%,中位生存期14.0个月,其单因素分析显示骨转移时ALP水平、骨转移时是否伴其他脏器诸因素对预后有影响。其Cox多因素分析显示骨转移时ALP水平、是否伴其他脏器转移、是否伴有淋巴结转移诸因素是影响预后的因子。
胃癌骨转移患者生存率,1年为47.1%,2年29.6%,3年24.7%,中位生存期5.5个月。其单因素分析显示骨转移时CEA水平、ALP水平对预后有一定影响。其Cox多因素分析显示骨转移时ALP水平及是否伴有淋巴结转移诸因素对预后有影响。
乳腺癌患者出现骨转移后其生存率明显下降,其骨转移患者生存率,1年为87.2%,2年68.3%,3年62.6%,5年46.9%,中位生存期43个月。其单因素分析显示是否伴有其他脏器转移及骨转移时ALP水平对预后有影响。Cox多因素分析显示乳腺癌骨转移患者的原发灶大小、骨转移时ALP水平、原发灶是否化疗、是否伴有淋巴结转移、骨旁软组织转移及其他脏器转移诸因素对预后无影响。
直肠癌骨转移以中老年患者居多,出现骨转移后其生存率明显下降。其骨转移患者生存率,1年为49.4%,2年27.5%,3年27.5%,中位生存期12个月。其单因素分析显示骨转移时ALP水平、是否伴其他脏器转移对预后有影响。其Cox多因素分析显示骨转移时ALP水平及原发灶大小二因素是影响预后的独立因子。
结论肝癌骨转移患者经外照射后症状明显缓解,但远期疗效仍然很差,对预计生存期短者,可考虑采用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。肝内原发灶控制情况、Karnofsky评分、骨转移时肝功能ALT水平和AST水平、血小板计数诸因素均为独立预后因子。这些预后因素对决定恰当的放射总剂量和单次照射剂量有所帮助。
前列腺癌骨转移灶数目、骨转移时ALP水平、诊断原发灶时Glason评分、年龄、非区域淋巴结转移诸因素是影响其预后的因子。其骨转移患者生存期长,远期疗效较好,其放疗的剂量分割方式,一般应以常规分割或30GY/10次为主。
肺癌骨转移时伴有一定比例的其他脏器转移,提醒我们在发现骨转移的同时应注意检查其他脏器。初诊时临床分期、骨转移时ALP水平、是否伴其他脏器转移及骨转移灶数目诸因素是影响预后的独立因子。其中位生存期13个月,对预计生存期短者,可考虑采用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。
肾癌骨转移时ALP水平、是否伴其他脏器转移及淋巴结转移诸因素是影响预后的独立因子。其中位生存期12个月,对预计生存期短者,用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。
胃癌患者出现骨转移后其生存率明显下降,骨转移时ALP水平及是否伴淋巴结转移诸因素是影响预后的因子。其生存期短,一般可考虑采用大剂量短疗程放射治疗或30GY/10次为主。
乳腺癌骨转移患者生存期长,远期疗效较好,对此类患者需积极处理其骨转移灶,照射方式应视每个患者具体情况而定,但以常规分割或30GY/10次为主。
直肠癌骨转移后其生存率明显下降,骨转移时ALP水平及原发灶大小二因素是影响其预后的独立因子。其中位生存期12个月,对预计生存期短者,用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。
Purpose To identify clinical features and independent.predictors for patients with bone metastases from thoracic or abdominal cancers(hepatocellular carcinoma(HCC), prostate cancer,non-small-cell lung cancer(NSCLC),kidney cancer,stomach cancer,breast cancer,rectum cancer).
Materials and Methods We retrospectively analysed 205 patients with bone metastases from HCC received external beam radiation therapy(EBRT) from 1997 to 2007 in department of radiation oncology,Fudan University Zhong Shan Hospital. Demographic variables,laboratory values,tumor characteristics(intrahepatic primary tumors and metastatic lesions) before EBRT and the treatments were recorded.Total radiation dose ranged from 32 to 60Gy(median:50Gy) and was focused on the involved bone.Statistical analysis was done using statistical package for social sciences,version 15.The Kaplan-Meier model was used to estimate the survival and control rates.The Cox proportion hazard model was used for multivariate analysis, occording to gender,KPS,liver function(Child-Pugh classification),HBsAg,tumor size and number,controll statuses of the intrahepatic lesions,level of AFP r-GT,ALT, AST,ALP,hemaglobulin,WBC,platelets,total bilirubin,albumin,A/G ratio,number of bone lesions,soft tissue expansion,liver transplantation history.
The cohorts involved the patients with bone metastases from prostate cancer (n=115),NSCLC(n=148),kidney caner(n=45),stomach cancer(n=38),breast cancer (n=46),and rectum cancer(n=32).The patients were followed up to Dec 31,2007.
Results One-,2-,3-year survival rates and median survival were 32.4%,13.2%, 8.5%and 7.4 months for patients with bone metastases from HCC,respectively.Of 205 patients with HCC,80(39%) was with expansile soft tissue masses,and Osteolytic lesions in most cases was found.Radiation dose was 32 to 66Gy.The relationship between dose and pain relief was not found,but the retreatment rate was higher in patients with expansile soft tissue.On univariate analyses,shorter survival was associated with poored performance status,lower albumin levels,higher alkaline phosphatase,r-glutamyltransferase and a-fetoprotein levels;tumor size＞5 cm, ucontrolled intrahepatic tumors;multifocal bone lesions,involvement of spinal vertebrae,extraosseous metastases,shorter disease-free interval after an initial diagnoses of HCC.On multivariate analysis,pretreatment unfavorable predictors were associated lower performance status;higher platelet count;higher aspartate aminotransferase,r-glutamyltransferase,and a-fetoprotein levels;uncontrolled intrahepatic tumor;and treatments received in the previous 5 years.
One-,2-,3-year survival rates and median survival were 89.1%,76.9%,60.9% and 48.5 months for patients with bone metastases from prostate cancer,respectively. On univariate analysis,age,Gleason score,stage,number of bone lesions,ALP level, non-local-regional lymph node metastases,other organ metastases were prognostic factors.On multivariate analysis using cox regression,number of bone lesions,ALP level,Gleason score,age,non-local-regional lymph node metastases were prognostic factors.
One-,2-,3-year survival rates and median survival were 52.2%,26.5%,3.7% and 13.0 months for patients with bone metastases from NSCLC,respectively.On univariate analysis,number of bone lesions,ALP level,other organ metastases were prognostic factors.On multivariate analysis using Cox regression method,stage,ALP level,other organ metastases,number of bone lesions were prognostic factors.
One-,2-,3-year survival rates and median survival were 54.0%,26.0%,17.3% and 14.0 months for patients with bone metastases from kidney cancer,respectively. On univariate analysis,ALP level,other organ metastases were prognostic factor.On multivariate analysis using Cox regression,ALP level,other organ metastases,lymph node metastases were prognostic factors.
One-,2-,3-year survival rates and median survival for patients with bone metastases from stomach cancer were 47.1%,29.6%,24.7%and 5.5 months, respectively.On univariate analysis,CEA level,ALP level were prognostic factors. On multivariate analysis using Cox regression,ALP level,lymph node metastases were prognostic factors.
One-,2-,3-year survival rates and median survival for patients with bone metastases from breast cancer were 87.2%,68.3%,62.6%and 43.0 months, respectively.On univariate analysis,other organ metastases,ALP level were prognostic factors.On multivariate analysis using Cox regression,size of primary tumors,ALP level,chemotherapy to primary tumors,lymph node metastases,with or without soft tissue expansion,other organ metastases were all entered with Backward:LR method and not significant prognostic factor was found.
One-,2-,3-year survival rates and median survival for patients with bone metastases from rectum cancer were 49.4%,27.5%,27.5%and 12 months, respectively.On univariate analysis,ALT level when bone metastases occurred,other organ metastases were prognostic factors.On multivariate analysis using Cox regression,ALT level when bone metastases occurred,primary tumor size were prognostic factors.
Conclusion Patients with bone metastases from HCC received EBRT had significant pain relief,but long term survival is still poor.Controlled intrahepatic tumor,Karnofsky score,ALT and AST level and liver function,platelet count are independent predictors.This study provides detailed information about clinical features,survival outcomes and prognostic factors for HCC with bone metastases in a relatively large cohort of patients treated with EBRT,these prognostic facrtors will help in determining which dose and fraction are appropriate.
Patents with bone metastases from prostate cancer received EBRT had significant pain relief,long term survival is high than bone metastasis from other caner,ALP level and gleason score,age,absence of regional lymph node metastases are independent predictors.For patients with bone metastases from prostate cancer,the bone lesions should be treated aggressively to improve patients' qualities of life.
Bone metastases from NSCLC often occompanied by other distant metastases beyond bone.EBRT can relive pain significantly.Stage,ALP level,other organ metastases,number of bone metastases were independent predictors.
The survival rate was lower in patients with bone metastases from kidney cancer than those without bone metastases.Patients' pain had been relief after EBRT.Long term follow up was poor.ALT level,other organ metastases,lymph node metastases when bone metastases occurred are independent prognostic factors.
The survival rate was the lowest in patients with bone metastases from stomach cancer comparison to those without bone metastases.ALT level,lymph node metastases when bone metastases occurred were prognostic factors.
The survival rate was lower in patients with bone metastases from breast cancer than those without bone metastases.Patients had apparent pain relief after EBRT,long term survival is high.For patients with bone metastases from breast cancer,the bone lesions should be treated aggressively to improve patients' qualities of life.
Patients with bone metastases from rectum cancer were mainly aged persons,the survival rate was low when metastases to bone.ALT level when bone metastases occurred,primary tumor size were prognostic factors.
收集本院1997～2007年间诊治的前列腺癌骨转移患者115例、非小细胞肺癌骨转移患者148例、肾细胞癌骨转移患者45例、胃腺癌骨转移患者38例、乳腺癌骨转移患者46例及直肠腺癌骨转移患者32例,收集其临床病史影像学及病理学检查资料、血液指标及治疗方法等。
上述病例均随访至2007年12月31日,均进行回顾性分析。
用SPSS15.0在Windows XP下进行单因素和多因素分析,生存率用Kaplan-Meier法计算,单因素分析用Log-rank方法,多因素分析采用Cox回归模型。
结果肝癌骨转移患者1、2、3年生存率分别为32.4%、13.2%、8.5%,中位生存期7.4个月。205名肝癌骨转移患者的特征是溶骨性破坏为主,伴有成骨成分,有80例(39%)骨转移灶周围伴有软组织肿块者。在照射剂量32～66Gy的患者中,我们并没有发现骨转移症状的减轻与剂量有明显关系,其剂量与效应之间并不呈正相关。不过骨转移灶周围伴有软组织肿块者的患者再治疗率相对比较高。通过单因素分析,我们发现较短的生存率和以下几方面有关:较低的Karnofsky评分、低白蛋白水平、较高的骨转移时ALP、r-GT和AFP水平、肝内肿瘤大于5cm、肝内原发灶未控、多发骨转移灶、累及脊椎、骨外其他脏器转移以及诊断肝癌至出现骨转移的时间较短。在多因素分析中,较低的Karnofsky评分、骨转移时较高的AFP水平、AST水平、血小板计数、肝内原发灶未控制、前5年的治疗诸因素均为独立预后因子(P值均＜0.05),与预后有关。
前列腺癌骨转移生存率,1年为89.1%,2年76.9%,3年60.9%,5年49.8%,中位生存期48.5个月。其单因素分析显示患者年龄、原发灶Gleason评分、初诊时临床分期、骨转移灶数目、发生骨转移时ALP水平、是否伴有非区域淋巴结转移、是否伴有其他脏器转移诸因素对预后有影响。其Cox多因素分析显示骨转移灶数目、骨转移时ALP水平、诊断原发灶时Gleason评分、年龄、非区域淋巴结转移诸因素对预后有影响。
肺癌骨转移患者生存率,1年为52.2%,2年26.5%,3年21.2%,5年3.7%,中位生存期13个月。其单因素分析显示骨转移灶数目、骨转移时ALP水平、骨转移时是否伴有其他脏器转移诸因素对预后有影响。其Cox多因素分析显示初诊时临床分期、骨转移时ALP水平、是否伴其他脏器转移及骨转移灶数目诸因素对预后有影响。
肾癌患者出现骨转移后其生存率明显下降,其骨转移患者生存率,1年为54.0%,2年26.0%,3年17.3%,中位生存期14.0个月,其单因素分析显示骨转移时ALP水平、骨转移时是否伴其他脏器诸因素对预后有影响。其Cox多因素分析显示骨转移时ALP水平、是否伴其他脏器转移、是否伴有淋巴结转移诸因素是影响预后的因子。
胃癌骨转移患者生存率,1年为47.1%,2年29.6%,3年24.7%,中位生存期5.5个月。其单因素分析显示骨转移时CEA水平、ALP水平对预后有一定影响。其Cox多因素分析显示骨转移时ALP水平及是否伴有淋巴结转移诸因素对预后有影响。
乳腺癌患者出现骨转移后其生存率明显下降,其骨转移患者生存率,1年为87.2%,2年68.3%,3年62.6%,5年46.9%,中位生存期43个月。其单因素分析显示是否伴有其他脏器转移及骨转移时ALP水平对预后有影响。Cox多因素分析显示乳腺癌骨转移患者的原发灶大小、骨转移时ALP水平、原发灶是否化疗、是否伴有淋巴结转移、骨旁软组织转移及其他脏器转移诸因素对预后无影响。
直肠癌骨转移以中老年患者居多,出现骨转移后其生存率明显下降。其骨转移患者生存率,1年为49.4%,2年27.5%,3年27.5%,中位生存期12个月。其单因素分析显示骨转移时ALP水平、是否伴其他脏器转移对预后有影响。其Cox多因素分析显示骨转移时ALP水平及原发灶大小二因素是影响预后的独立因子。
结论肝癌骨转移患者经外照射后症状明显缓解,但远期疗效仍然很差,对预计生存期短者,可考虑采用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。肝内原发灶控制情况、Karnofsky评分、骨转移时肝功能ALT水平和AST水平、血小板计数诸因素均为独立预后因子。这些预后因素对决定恰当的放射总剂量和单次照射剂量有所帮助。
前列腺癌骨转移灶数目、骨转移时ALP水平、诊断原发灶时Glason评分、年龄、非区域淋巴结转移诸因素是影响其预后的因子。其骨转移患者生存期长,远期疗效较好,其放疗的剂量分割方式,一般应以常规分割或30GY/10次为主。
肺癌骨转移时伴有一定比例的其他脏器转移,提醒我们在发现骨转移的同时应注意检查其他脏器。初诊时临床分期、骨转移时ALP水平、是否伴其他脏器转移及骨转移灶数目诸因素是影响预后的独立因子。其中位生存期13个月,对预计生存期短者,可考虑采用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。
肾癌骨转移时ALP水平、是否伴其他脏器转移及淋巴结转移诸因素是影响预后的独立因子。其中位生存期12个月,对预计生存期短者,用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。
胃癌患者出现骨转移后其生存率明显下降,骨转移时ALP水平及是否伴淋巴结转移诸因素是影响预后的因子。其生存期短,一般可考虑采用大剂量短疗程放射治疗或30GY/10次为主。
乳腺癌骨转移患者生存期长,远期疗效较好,对此类患者需积极处理其骨转移灶,照射方式应视每个患者具体情况而定,但以常规分割或30GY/10次为主。
直肠癌骨转移后其生存率明显下降,骨转移时ALP水平及原发灶大小二因素是影响其预后的独立因子。其中位生存期12个月,对预计生存期短者,用大剂量短疗程放射治疗,预计生存期长者,采用常规分割。
Purpose To identify clinical features and independent.predictors for patients with bone metastases from thoracic or abdominal cancers(hepatocellular carcinoma(HCC), prostate cancer,non-small-cell lung cancer(NSCLC),kidney cancer,stomach cancer,breast cancer,rectum cancer).
Materials and Methods We retrospectively analysed 205 patients with bone metastases from HCC received external beam radiation therapy(EBRT) from 1997 to 2007 in department of radiation oncology,Fudan University Zhong Shan Hospital. Demographic variables,laboratory values,tumor characteristics(intrahepatic primary tumors and metastatic lesions) before EBRT and the treatments were recorded.Total radiation dose ranged from 32 to 60Gy(median:50Gy) and was focused on the involved bone.Statistical analysis was done using statistical package for social sciences,version 15.The Kaplan-Meier model was used to estimate the survival and control rates.The Cox proportion hazard model was used for multivariate analysis, occording to gender,KPS,liver function(Child-Pugh classification),HBsAg,tumor size and number,controll statuses of the intrahepatic lesions,level of AFP r-GT,ALT, AST,ALP,hemaglobulin,WBC,platelets,total bilirubin,albumin,A/G ratio,number of bone lesions,soft tissue expansion,liver transplantation history.
The cohorts involved the patients with bone metastases from prostate cancer (n=115),NSCLC(n=148),kidney caner(n=45),stomach cancer(n=38),breast cancer (n=46),and rectum cancer(n=32).The patients were followed up to Dec 31,2007.
Results One-,2-,3-year survival rates and median survival were 32.4%,13.2%, 8.5%and 7.4 months for patients with bone metastases from HCC,respectively.Of 205 patients with HCC,80(39%) was with expansile soft tissue masses,and Osteolytic lesions in most cases was found.Radiation dose was 32 to 66Gy.The relationship between dose and pain relief was not found,but the retreatment rate was higher in patients with expansile soft tissue.On univariate analyses,shorter survival was associated with poored performance status,lower albumin levels,higher alkaline phosphatase,r-glutamyltransferase and a-fetoprotein levels;tumor size＞5 cm, ucontrolled intrahepatic tumors;multifocal bone lesions,involvement of spinal vertebrae,extraosseous metastases,shorter disease-free interval after an initial diagnoses of HCC.On multivariate analysis,pretreatment unfavorable predictors were associated lower performance status;higher platelet count;higher aspartate aminotransferase,r-glutamyltransferase,and a-fetoprotein levels;uncontrolled intrahepatic tumor;and treatments received in the previous 5 years.
One-,2-,3-year survival rates and median survival were 89.1%,76.9%,60.9% and 48.5 months for patients with bone metastases from prostate cancer,respectively. On univariate analysis,age,Gleason score,stage,number of bone lesions,ALP level, non-local-regional lymph node metastases,other organ metastases were prognostic factors.On multivariate analysis using cox regression,number of bone lesions,ALP level,Gleason score,age,non-local-regional lymph node metastases were prognostic factors.
One-,2-,3-year survival rates and median survival were 52.2%,26.5%,3.7% and 13.0 months for patients with bone metastases from NSCLC,respectively.On univariate analysis,number of bone lesions,ALP level,other organ metastases were prognostic factors.On multivariate analysis using Cox regression method,stage,ALP level,other organ metastases,number of bone lesions were prognostic factors.
One-,2-,3-year survival rates and median survival were 54.0%,26.0%,17.3% and 14.0 months for patients with bone metastases from kidney cancer,respectively. On univariate analysis,ALP level,other organ metastases were prognostic factor.On multivariate analysis using Cox regression,ALP level,other organ metastases,lymph node metastases were prognostic factors.
One-,2-,3-year survival rates and median survival for patients with bone metastases from stomach cancer were 47.1%,29.6%,24.7%and 5.5 months, respectively.On univariate analysis,CEA level,ALP level were prognostic factors. On multivariate analysis using Cox regression,ALP level,lymph node metastases were prognostic factors.
One-,2-,3-year survival rates and median survival for patients with bone metastases from breast cancer were 87.2%,68.3%,62.6%and 43.0 months, respectively.On univariate analysis,other organ metastases,ALP level were prognostic factors.On multivariate analysis using Cox regression,size of primary tumors,ALP level,chemotherapy to primary tumors,lymph node metastases,with or without soft tissue expansion,other organ metastases were all entered with Backward:LR method and not significant prognostic factor was found.
One-,2-,3-year survival rates and median survival for patients with bone metastases from rectum cancer were 49.4%,27.5%,27.5%and 12 months, respectively.On univariate analysis,ALT level when bone metastases occurred,other organ metastases were prognostic factors.On multivariate analysis using Cox regression,ALT level when bone metastases occurred,primary tumor size were prognostic factors.
Conclusion Patients with bone metastases from HCC received EBRT had significant pain relief,but long term survival is still poor.Controlled intrahepatic tumor,Karnofsky score,ALT and AST level and liver function,platelet count are independent predictors.This study provides detailed information about clinical features,survival outcomes and prognostic factors for HCC with bone metastases in a relatively large cohort of patients treated with EBRT,these prognostic facrtors will help in determining which dose and fraction are appropriate.
Patents with bone metastases from prostate cancer received EBRT had significant pain relief,long term survival is high than bone metastasis from other caner,ALP level and gleason score,age,absence of regional lymph node metastases are independent predictors.For patients with bone metastases from prostate cancer,the bone lesions should be treated aggressively to improve patients' qualities of life.
Bone metastases from NSCLC often occompanied by other distant metastases beyond bone.EBRT can relive pain significantly.Stage,ALP level,other organ metastases,number of bone metastases were independent predictors.
The survival rate was lower in patients with bone metastases from kidney cancer than those without bone metastases.Patients' pain had been relief after EBRT.Long term follow up was poor.ALT level,other organ metastases,lymph node metastases when bone metastases occurred are independent prognostic factors.
The survival rate was the lowest in patients with bone metastases from stomach cancer comparison to those without bone metastases.ALT level,lymph node metastases when bone metastases occurred were prognostic factors.
The survival rate was lower in patients with bone metastases from breast cancer than those without bone metastases.Patients had apparent pain relief after EBRT,long term survival is high.For patients with bone metastases from breast cancer,the bone lesions should be treated aggressively to improve patients' qualities of life.
Patients with bone metastases from rectum cancer were mainly aged persons,the survival rate was low when metastases to bone.ALT level when bone metastases occurred,primary tumor size were prognostic factors.
引文
[1]Coleman RE.Skeletal complications of malignancy[J].Cancer,1997,80(8suppl):1558-1594.
[2]Johnson JR,Grant Williams G,Pazdur R.End Points and United States Food and DrugAdministration Approvel of Oncology Drugs[J].J Clin Oncol.2003,21(7):1404 -1411.
[3]Kinnane N.Burden of bone disease[J].Eur J Oncol Nurs,2007,11(suppl 2):28-31.
[4]Chow E,Danjoux C,Connolly R,et al.Bone metastasis:review and critical analysis of random allocation trial of local field treatment:regarding Ratanatharathorn.Int J Radiat Oncol Biol Phys[J],2000,46(2):517-518.
[5]Conroy T,L Malissard,Dartois D.et al.Natural history and development of bone metastasis.Apropos of 429 cases[J].Bull Cancer,1998,75(9):845-857.
[6]Kong W,Zhang-Salomons J,Hanna TP,et al.A population-based study of the fractionation of palliative radiotherapy for bone metastasis in Ontario[J].Int J Radiat Oncol Biol Phys,2007,69(4):1209-1217.
[7]Fukutomi M,Yokota M,Chuman 14,et al.Increased incidence of bone metastases in hepatocellular carcinoma[J].Eur J Gastroenterol Hepatol,2001,13(9):1083-1088.
[8]肖亚景,苏敏,杨健,等.肝癌骨转移的特点及核素骨显像的价值[J].放射学践,2004.19(9):682-684.
[9]Koom WS,Seong JS,Lee M J,et al.Radiation therapy for bone metastasis from hepatocellular carcinoma[J].Taehan Kan Hakhoe Chi,2002,8(3):304-311.
[10]Kodama H,Aikata H,Uka K,et al.Efficacy of percutaneous cementoplasty for bone metastasis from hepatocellular carcinoma[J].Oncology,2007,72(5-6):285-292.
[11]中国抗癌协会肝癌专业委员会.原发性肝癌的临床诊断与分期标准[J].中华肝脏病杂志,2001,9(6)324.
[12]但汉雷,赵燕,张亚历,等.细针活检确诊以骨转移为首发表现的疑难性肝细胞癌(附2例报告)[J].第一军医大学学报,2002,22(11):978-980.
[13]Melichar B,Voboril Z,Toupková M,et al.Hepatocellular carcinoma presenting with bone metastasis[J]. J Exp Clin Cancer Res ,2002,21(3): 433-436.
[14] Albers I, Hartmann H, Bircher J, et al. Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis[J]. Scand J Gastroenterol, 1989,24(3): 269-276.
[15] Wilkie D, Loverjoy N, Dodd M, et al. Cancer pain intensity measurement:
concurrent validity of three tools - fignger dynamometer, pain intensity number scale , visual analogue scal [J] .Hosp J ,1990 ,6 (1) :1.
[16] Ciray I, Astrom G, Andreasson I, et al. Evaluation of new sclerotic bone
metastases in breast cancer patients during treatment [J]. Acta Radiol, 2000 ; 41 (2) : 178.
[17] Suto Y, Iwamiya T, Tanigawa N, et al. Clinical experience of 123I-IMP scintigraphy in detecting vertebral bone metastases of hepatocellular carcinoma. A comparison with bone scintigraphy with 99mTc-MDP[J]. Acta Radiol ,1994,35(2): 159-163.
[18] Okazaki N,Yoshino M,Yoshida T, et al. Bone metastasis in hepatocellular carcinoma [J]. Cancer ,1985,55(9): 1991-1994.
[19] Sato M, Ishida H, Konno K et al. Peripheral bone metastasis from hepatocellular carcinoma: sonographic findings[J]. Abdom Imaging ,2001, 26(5): 524-528.
[20] Otsuka N, Fukunaga M, Morita K, et al. Photon-deficient finding in sternum on bone scintigraphy in patients with malignant disease[J]. Radiat Med ,1990,8(5): 168-172.
[21] Body JJ.Breast cancer: bisphosphonate therapy for metastatic bone disease [J]. Clin Cancer Res, 2006 Oct 15;12(20 Pt 2):6258-6263.
[22] Seratini AN. Therapy of metastatic bone pain [J].J Nucl Med ,2001,42(6):895 -906.
[23] Seong J, Koom WS, Park HC. Radiotherapy for painful bone metastases from hepatocellular carcinoma [J]. Liver Int 2005;25:261—265.
[24] Fontana T, Siciliano M, Franceschelli A, et al. An atypical bone metastasis of hepatocellular carcinoma: case report and review of the literature [J]. Clin Ter ,2004,155(10): 447-451.
[25] Toyoda H, Kumada T, Kiriyama S, et al. Changes in the characteristics and survival rate of hepatocellular carcinoma from 1976 to 2000.,Analysis of 1365patients in a single institution in Japan[J].Cancer 2004;100:2415-2421.
[26]Ratanatharathorn V,Powers WE,Moss WT,et al.Bone Metastases:review and critical analysis of random allocation trials of local field treatment[J].Int J Radiat Oncol Biol Phys,1999,44(1):1-18.
[27]Kaizu T,Karasawa K,Tanaka Y,et al.Radiotherapy for osseous metastases from hepatocellular carcinoma:a retrospective study of 57 patients.[J]Am J Gastroenterol,1998,93(11):2167-2171.
[28]Seong J,Koom WS,Park HC.Radiotherapy for painful bone metastases from hepatocellular carcinoma[J].Liver Int 2005;25:261-265.
[29]Goblirsch MJ,Zwolak PP,Clohisy DR.Biology of bone cancer pain.Clin Cancer Res 2006;12:6231s-6235s.
[30]Suganuma T,Terauchi R,Shikina A,et al.A case of hepatocellular carcinoma with bone metastasis responding to concurrent TS-1/low-dose cisplatin(CDDP) therapy and radiotherapy[J].Gan To Kagaku Ryoho,2004,31(5):781-784.
[31]何健,曾昭沖,汤钊猷.原发性肝癌骨转移的相关预后因素分析及放疗效[J].中华放射肿瘤学杂志,2005,14(6):479.
[32]Rades D,Rudat V,Veninga T,et al.Prognostic factors for functional outcome and survival after reirradiation for in-field recurrences of metastatic spinal cord compression[J].Cancer 2008;113(5):1090-1096.
[33]Otsuka N,Fukunaga M,Morita K,et al.Photon-deficient finding in sternum on bone scintigraphy in patients with malignant disease[J].Radiat Med,1990,8(5):168-172.
[34]Dallari R,Gazzotti GL,Barozzini P,et al.Bone metastasis as a sign of the existence of latent neoplasia[J].Minerva Med,1986,77(22-23):981-987.
[35]Drago,J.R.Diagnostic techniques in prostatic cancer[J].Postgrad Med,1986,80(1):214-217,220,222-224.
[36]Farmer KD,Gellett LR,Vivian GC,Franklin K.Bladder diverticulum simulating a pelvic metastasis on a Tc-99m HDP bone scan[J].Clin Nucl Med,2001,26(1 ):60-61.
[37]Reddi AH,Roodman D,Freeman C,Mohla S.Mechanisms of tumor metastasis to the bone: challenges and opportunities [J]. J Bone Miner Res, 2003,18(2): 190-194.
[38] Kageyama Y, Kihara K, Kamata S, et al. Relationship between pretreatment serum levels of prostate specific antigen and bone metastasis in prostate cancer [J]. Hinyokika Kiyo ,1996,42(3): 197-199.
[39] Xu J, Wang R, Xie ZH, et al. Prostate cancer metastasis: role of the host microenvironment in promoting epithelial to mesenchymal transition and increased bone and adrenal gland metastasis [J]. Prostate ,1996,66(15): 1664-1673.
[40] Imai K, Suzuki T, Shimizu T, et al. Analysis of survival of prostate cancer patients in Japan and the USA [J]. Adv Exp Med Biol, 1992,324: 29-38.
[41] Knerr K, Ackermann K, Neidhart T, Pyerin W. Bone metastasis: Osteoblasts affect growth and adhesion regulons in prostate tumor cells and provoke osteomimicry [J]. Int J Cancer, 2004,111(1): 152-159.
[42] Cheville JC, Tindall D, Boelter C, et al. Metastatic prostate carcinoma to bone: clinical and pathologic features associated with cancer-specific survival [J]. Cancer, 2002, 95(5): 1028-1036.
[43] Carlinfante G, Vassiliou D, Svensson O, et al. Differential expression of osteopontin and bone sialoprotein in bone metastasis of breast and prostate carcinoma [J]. Clin Exp Metastasis , 2003,20(5): 437-444.
[44] El Otmany A, Bouklata S, Hafid H, et al. Bone metastasis revealing a primary prostate cancer [J]. J Radiol, 2000,81(9): 990-991.
[45] Katakami, N. Lung cancer with bone metastasis [J]. Gan To Kagaku Ryoho, 2006,33(8): 1049-1053.
[46] Ryo H, Sakai H.Bone metastasis of primary lung cancer [J]. Nihon Kokyuki Gakkai Zasshi, 1998,36(4): 317-322.
[47] 林学德,张晶.肺癌骨转移的临床特点分[J].中国肿瘤临床与康复,2000,7(5):38
[48] Koizumi M, Takahashi S, Ogata E. Comparison of serum bone resorption markers in the diagnosis of skeletal metastasis [J]. Anticancer Res , 2003,23(5b): 4095-4099.
[49] Sugiura H, Yamada K, Sugiura T, et al. Predictors of survival in patients with bone metastasis of lung cancer [J]. Clin Orthop Relat Res , 2008,466(3): 729-736.
[50]要洁,张湘茹.非小细胞肺癌骨转移的临床特点分析[J].实用癌症杂志,2004,19(4):392.
[51]周静,陈绪元,杨万毅,陈晓品.放疗联合化疗对60例肺癌骨转移的疗效分析[J].重庆医学,2007,36(7):634-635.
[52]Tsuya A,Fukuoka M.Bone metastases in lung cancer[J].Clin Calcium,2008,18(4):455-459.
[53]Hatano T,Suzuki K,Nagashima A,et al.Radiation therapy for bone metastasis from renal cell carcinoma with emphasis on local control[J].Hinyokika Kiyo,2007,53(10):687-690.
[54]Méndez López JM,García Mas R,Salvà Coll G.Metastasis of an adenocarcinoma of the colon to the 1st metacarpal bone[J].Ann Chir Main Memb,1997,Super 16(2):134-137.
[55]Weber KL,Doucet M,Price JE.Renal cell carcinoma bone metastasis:epidermal growth factor receptor targeting[J].Clin Orthop Relat Res,2003,(415 Suppl):S86-94.
[56]Sagoh M,Kodaki K,Ichikizaiki K,et al.Skull base metastasis from renal cell carcinoma presenting as abducens nerve paresis:report of two cases[J].No Shinkei Geka,1996,24:729.
[57]Seaman E,Goluboff ET,Ross S,et al.Association of radionuclide bone scan and serumalkaline phosphatase in patients with metastatic renal cell carcinoma[J].Urology,1996,48:692.
[58]Nakano S,Hasegawa Y,Ibuka K,et al.Survey for primary tumor site in patients with initial clinical presentation of bone metastasis[J].Kaku Igaku,1993,30(9):1049-1054.
[59]Weber KL,Pathak S,Multani AS,et al.Characterization of a renal cell carcinoma cell line derived from a human bone metastasis and establishment of an experimental nude mouse model[J].J Urol,2002,168(2):774-779.
[60]Inberg MV,Laurén P,Vuori J,Viikari SJ.Prognosis in intestinal-type and diffuse gastric carcinoma with special reference to the effect of the stromal reaction[J].Acta Chir Scand,1973,139(3):273-278.
[61]Etoh T,Baba H,Taketomi A,et al.Diffuse bone metastasis with hematologic disorders from gastric cancer:clinicopathological features and prognosis[J].Oncol Rep,1999,6(3):601-605.
[62]Yoshikawa K,Kitaoka H.Bone metastasis of gastric cancer[J].Jpn J Surg,1983,13(3):173-176.
[63]Nishidoi H,Koga S.Clinicopathological study of gastric cancer with bone metastasis[J].Gan To Kagaku Ryoho,1987,14(5 Pt 2):1717-1722.
[64]谢昌辉,王江桥,陈羽中.胃癌骨转移相关因素探讨[J].河南医科大学学报,1997,32(4):53.
[65]荣维淇,吴健雄眉癌骨转移的诊断与综合治疗[J].中国骨肿瘤骨病,2003.2(2):83-87.
[66]Sudo H,Takagi Y,Katayanagi S,et al.Bone metastasis of gastric cancer[J].Gan To Kagaku Ryoho,2006,33(8):1058-1060.
[67]Etoh T,Baba H,Taketomi A,et al.Sequential methothrextate and 5-fruororacil therapy for diffuse bone metastasis from gastric cancer[J].Anticancer Res,1998,18(3B):2085-2088.
[68]Hironaka SI,Boku N,Ohtsu A,et al.Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with bone metastasis[J].Gastric Cancer,2000,3(1):19-23.
[69]Coleman RE,Fogelman I,Habibollahi F,et al.Selection of patients with breast cancer for routine follow-up bone scans[J].Clin Oncol(R Coll Radiol),1990,2(6):328-332.
[70]Yu J J,Brennan M,Christos P,et al.Bone marrow micrometastases and adjuvant treatment of breast cancer[J].Breast J,2004,10(3):181-185.
[71]王跃珍,孙晓江,刘林林,等.208例乳腺癌骨转移相关因素分析[J].中国实验诊断学,2004,(04)406-407.
[72]朱旭生,莫耀薄,邹德环.乳腺癌术后核素全身骨显像临床价值[J]中华核医学杂志,2000,20(4):155.
[73]张武,高琦,张玲,等.多项肿瘤标志物对肿瘤敏感性的实测统计[J].放射免疫学杂志,2001.14(6):355-356.
[74]Bares,R.Skeletal scintigraphy in breast cancer management[J].Q J Nucl Med,1998,42(1):43-48.
[75]Kinne,DW.Staging and follow-up of breast cancer patients[J].Cancer,1990,67(4Suppl):1196-1198.
[76]吴昊,邵志敏,沈坤炜,等.乳腺癌骨转移相关的临床病理因素的研究[J].中国癌症杂志,2003,13(4):316-318.
[77]Kunkler IH,Merrick MV,Rodger A.Bone scintigraphy in breast cancer:A nine-year follow-up[J].Clinical Radiology.1985,36(3):279-282.
[78]邓豪余;段华新;邱娟.乳腺癌患者腋窝淋巴结转移与骨转移关系分析[J].湖南医科大学学报.2001,26(3):269-270.
[79]Holland R,Connolly JL,Gelman R,et al.The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast[J].J Clin Oncol,1990,8(1):113-118.
[80]龙启明,胡锐,申晓敏,等.乳腺癌骨转移106例临床分析[J].中国普外基础与临床杂志.2004,11(1):11-12.
[81]Vincent-Salomon A,Bidard FC,Pierga JY.Bone marrow micrometastasis in breast cancer:review of detection methods,prognostic impact and biological issues[J].J Clin Pathol,2008,61(5):570-576.
[82]刘宝善,主编.大肠肛门肿瘤学[M].第1版.成都:四川科学技术出版社,1998.464-465.
[83]张莉华,谢文晖,俞志昌.1500例肺癌患者核素骨显像结果分析[J].中华核医学杂志,1999,19:627.
[84]刘放,丁秀杰,张菁茹,等.大肠癌骨转移191例临床分析[J].中华普通外科杂志.2001.16(6).354-355.
[1]陈晓钟.骨转移瘤的临床研究进展,中国肿瘤杂志[J],2006,15(3):135-139.
[2]曹来宾,王安明,徐爱德等.1047例骨转移瘤的影像学诊断[J].中华放射肿瘤学杂志,1997,3l(8):547-551.
[3]骆红蕾,陈凡.骨转移癌放射治疗的疗效观察[J].中华放射肿瘤学杂志,2004,13(4):318.
[4]李小平,陈震,黄雯霞等.36例原发性肝癌合并骨转移的治疗[J].中国肿瘤临床,2003,30(3):220-221.
[5]苏锡龙.65例骨转移癌放射止痛瘤效果分析[J].中华放射肿瘤学杂志,2003,12(2):135.
[6]肖必文.胃癌术后36例骨转移[J].中国肿瘤临床,2002,9(7):471-473.
[7]余子豪.骨转移癌放射治疗进展[J].中国骨肿瘤骨病,2002,1(1):13-14.
[8]李云海,陆雪官,潘自强等.45例前列腺癌临床分析[J].中华放射肿瘤学杂志,2002,11(1):23-26.
[9]Clain A.Secondary malignant disease of bone[J].Br J Cancer,1965,19:15-29.
[10]Bilsky MH,Shannon FJ,Sheppard AS,et al.Diagnosis and management of a metastatic tumor in the atlantoaxia]spine.Spine,2002,27:1062-1069.
[11]徐万鹏.骨转移瘤的诊断与治疗[A].张天泽,徐光炜.肿瘤学(下册)[M].天津:天津科学技术出版社,1996.2580-2581.
[12]Coleman RE.Skeletal complications ofmalignancy[J].Cancer,1997,80(Ssuppl):1558-1594
[13]John R.Johnson,Grant Williams,et al.End Points and United States Food and Drug Administration Approvelof Oncology Drugs.J Clin Oncol,21:1404-1411.
[14]Kinnane N.Burden of hone disease.Eur J Oncol Nurs,207,11 suppl 2:S28-31
[15]Higinbotham NL,Marcove RC.The management of pathological fractures[J].J Trauma,1965,5(6):792- 798.
[16]陈宏远,谭毅等.基质细胞衍生因子-1及其受体CXCR4在肿瘤转移中的作用[J].生物医学工程杂志,2007,24(5):1180-1183.
[17] Koo BH, Oh D, Chung SY, et al. Deficiency of von Willebrand factor-cleaving protease activity in the plasma of malignant patients [J]. Thromb Res, 2002,105 (6): 471- 476.
[18] Bailey JM, Singh PK, Hollingsworth MA. Cancer metastasis facilitated by developmental pathways: Sonic hedgehog, Notch, and bone morphogenic, proteins [J]. J Cell Biochem, 2007, 102 (4): 829-839.
[19] Dittmar T , Heyder C, Gloria-Maercker E, et al. Adhesion molecules and chemokines: the navigat ion system for circulating tumor (stem) cells to metastasize in an organ-specific manner [J]. Clin Exp Metastasis, 2008, 25 (1): 11- 32.
[20] Wai PY, Kuo PC. Osteopont in: regulation in tumor metastasis [J].Cancer Metastasis Rev, 2008, 27 (1):103- 118.
[21] Yang S, Du J, Wang Z, et al. BMP-6 promotes E-cadherin expression through repressing deltaEFl in breast cancer cells [J]. BMC Cancer,2007, 7 (1): 211- 213.
[22] Harvey JR, Mellor P, EldalyH, et al. Inhibition of CXCR4-mediated breast cancer metastasis: a potential role for heparinoids [J ].Clin Cancer Res, 2007, 13 (5): 1562- 1570.
[23] Liang Z, Wu H, Reddy S, et al. Blockade of invasion and metastasis of breast cancer cells via targeting CXCR4 with an artificial microRNA[J]. Biochem Biophys Res Commun, 2007, 363 (3) : 542- 546.
[24] Liao J , McCauley LK. Skeletal metastasis: Established and emerging roles of parathyroid hormone related protein (PTH rP) [J]. Cancer Metastasis Rev, 2006, 25 (4) : 559- 571.
[25] Elena N , Sandra A , Tiffiney R, et al. HEF1-Dependent Aurora A Activation Induces Disassembly of the Primary Cilium [J]. Cell,2007, 129 (7) : 1351- 1363.
[26] Curtis CD, Likhite VS, McLeod IX, et al. Interaction of the tumor metastasis suppressor nonmetastatic protein 23 homologue H1 and estrogen receptor alpha alters estrogen-responsive gene expression [J].Cancer Res, 2007, 67 (21) : 10600- 10607.
[27] Van Sant C, Wang G, Anderson MG, et al. Endothelin signaling in osteoblasts: global genome view and implication of the calcineurin/NFAT pathway [J]. Mol Cancer Ther, 2007,6(1): 253 -261.
[28]Guise TA,Kozlow WM,Heras-Herzig A,et al.Molecular mecharisna of breast cancer metastases Clin Breast Cancer,2005 Suppl 2:S46-53
[29]Li Y,Cozzi PJ.Targeting uPA/uPAR in prostate cancer[J].Cancer Treat Rev,2007,33(6):521 -527.
[30]潘颂华.转移性骨肿瘤影像学诊断和治疗进展,上海医学影像,2008,17(2):174-177
[31]Rybak LD,Rosent hal DI.Radiological imaging for diagnosis of bone metastases.Q J Nucl Med,2001,45(3):53-64.
[32]Algra PR,Bloem JL,Tissing H,et al.Detection of vertebral metastases:Comparison between magnetic resonance imaging and bone scintigraphy[J].Radiographics,1991,11:219.
[33]Rosenbaum SJ,Lind W,Antoch G,et al.False- positive FDG- PET uptake- the role of PET/CT[J].Eur Radiol,2005,17:1
[34]田嘉禾主编.PET、PET/CT诊断学.北京:化学工业出版社医学出版分社,2007,368.
[35]曹海燕,刘露,何国城.血清Ⅰ CTP在前列腺癌骨转移诊断和疗效观察中的应用[J],中国医药导报2007,4(11):101-102.
[36]Lin A,RayM E.Targeted and systemic radio therapy in the treatment of bone metastasis[J].Cancer Metastasis Rev,2006,25(4):669-673.
[37]Ricco AI,Wodajo FM,Malawer M.Metastatic Carcinoma of the Long Bones[J].Am Fam Physician,2007,76(10):1489- 1494.
[38]傅深,陆嘉德.前列腺癌骨骼转移的治疗策略[J].中国癌症杂志,2007,17(3):213- 219.
[39]杨全成,徐勇.前列腺癌骨转移的治疗进展[J].国际泌尿系统杂志,2004,24(2):153-157.
[40]Williams&W ilk ins,OsborneCK.Adjuvant endocrine therapy[A].In:Harris,Lippman,Morrow,et al.Eds.Diseases of the breast[M].3rd Ed.USA.Lippincot:2004:865- 891.
[41]Rosen LS,Gordon DH,Dugan WJ,et al.Zoledronic acid is superior to pamidronate for the treatment of bone metastases in breast.carcinoma patients with at least one osteolytic lesion[J].Cancer,2004,100(1):36- 43.
[42]Saad F,Karakiewicz P,Perrotte P.The role of bispho sphonates in hormone- refractory prostate cancer[J].World J Urol,2005,23(1):14- 18.
[43]WHO.Medical need for opioid analgesics.Achieving balance in national opiooids control policy;Guidelinnes for Asessment Geneva:WHO Publication,2000,3-4.
[44]邹萍,蔡宗萍.~(153)Sm-EDTMP治疗1024例骨转移癌疗效分析[J].重庆医学,2005.34(8):1140-1141.
[45]Wang RF,Zhang CL,Zhu SL,et al.Comparative study of ~(153)Sm -EDTMP with pamidronate disodium in the treatment of patients with painful metastatic bone cancer[J].Med Princ Pract(MPP),2003,12(2):97-101.
[46]Zgiammarile F,Mognetti T,Resche I,eta].Bone pain palliation with 89Sr in cancer patients with bone metastases[J].Q J Nucl Med,2001,45(1):78- 83.
[47]刘继中,王臻等.骨转移癌的外科治疗[J],中国肿瘤临床.2001,28(8):579-584
[48]邓钢,何仕诚等.经皮椎体成形术治疗脊柱恶性肿瘤[J].介入放射学杂志,2005.14(3):261-264.
[49]王振堂,林琳,赫强等.椎体成形术的临床应用[J].中华放射学杂志,2004,38(12):1301-1303.
[50]Barnes EA,Parliament M,Henson J,et al.Palliative radiotherapy for patients with bone metastases[J[.Radiother Oncol,2003,67:221- 223.
[51]Milker-Eabel S,Eabel A,Thilman C,et al.Clinical results of retreatment of vertebral bone metasteses by stereotastic conformal radiotherapy and intensity-modulated radiotherapy[J].Int J Radiat Oncol Biol Phys,2003,55(1):162- 167.
[52]钟立松,张仟仕,赵雷等.常规分割与大分割放射治疗转移性骨痛患者的疗效观察[J].四川肿瘤防治,2005,18(3):187-188.
[53]Hoskin PJ,Ford HT,Harmer CL.Hemibody irradiation(HBI) for metastatic bone pain in two histologically distinct groups of patients[J].Clin Oncol(R Coll Radiol).1989,1(2):67-69.
[54]aiewald,M.,et al.Rapid course radiation therapy vs.more standard treatment:a randomized trial for bone metastases[J].Int J Radiat Oncol Biol Phys,1996.36(5):1085-1089.
[55]谭榜宪,周业琴,柳弥.116例骨转移癌放射治疗止痛效果分析[J].肿瘤学杂志,2003,9(6):332-333.
1 Nakashima T,Okuda K,Kojiro M,et al.Pathology of hepatocellular carcinoma in japan.232 Consecutive cases autopsied in ten years.Cancer,1983,51:863-877.
2 中国抗癌协会肝癌专业委员会.原发性肝癌的临床诊断与分期标准.中华肝脏病杂志,2001,9:324.
3 Asahara T,Dohi K,Hino H,et al.A case of HCC with bone metastasis responding to radiotherapy after successful hepatectomy of primary lesion.Hiroshima J Med Sci,1999,48:35-39.
4 Healey JH,Brown HK.Complications of bone metastases.Cancer,2000,88 Suppl 12:2940-2951.
5 Imamura H,Masutani S,Tatsuta M,et al.A case report of successful transcatheter arterial embolization therapy for osseous metastasis of HCC.Gan To Kagaku Ryoho,2000,27:1941-1946.
6 Seratini AN.Therapy of metastatic bone pain.J Nucl Med,2001,42:895-906.
7 Ratanatharathorn V,Powers WE,Moss WT,et al.Bone metastasis:review and critical analysis random allocation trials of local field treatment.Int J Radiat Oncol Biol Phys,1999,44:1-8.
8 Janjan N.Bone metastasis:Approaches to management.Semi Oncol,2001,28(4 Suppl 11):28-34.
9 Nielsen OS,Munro AJ,Tannock IF.Bone metastases:pathophysiology and management policy.J Clin Oncol,1991,9:509-524.
10 Rasmusson B,Vejborg I,Jensen AB,et al.Irradiation of bone metastases in breast cancer patients:a randomized study with 1 year follow up.Radiother Oncol,1995,34:179-184.
11 Coleman RE,Rubens RD.Bone Metastases.In:Martin DA,James OA,Allen SL,et al eds.Clinical Oncology.2nd ed.Livingstone:Harcourt Asia Churchill,2001.852.
12 陈允清.56例骨转移癌的放疗止痛效果分析.中华放射肿瘤学杂志,2000,9:234.
13 Buchali K,Correnes HJ,Schuerer M,et al.Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma.Eur J Nucl Med,1988,14:349-351.
14 Laing AH,Ackery DM,Bayly RJ,et al.Strontium-89 chloride for pain palliation in prostatic skeletal malignancy.Br J Radiol,1991,64:816-822.
15 冯勤富,姑息性放射治疗.见:殷蔚伯,谷铣之,主编.肿瘤放射治疗学(第三版).北京:中国协和医科大学出版社,2002.1088-1090.
16 Rose C,Kagan R.The final report of the expert panel for the radiation oncology bone metastasis work group of the American College of Radiology.Int J Radial Oncol Biol Phys,1998,40:1117-11124.
17 Iwata M,Kaneko S,Terasaki S,et al.Importance of achieving complete necrosis during the first treatment for HCC to prevent bone metastasis:a prospective study.J Gastroenterol Hepatol,2001,16:46-51.
18 Fan ST,Ng IO,Poon RT,et al.Hepatectomy for Hepatocellular carcinoma:the surgeo's role in long-term survival.Arch Surg,1999,134:1124-1130.
[2]Johnson JR,Grant Williams G,Pazdur R.End Points and United States Food and DrugAdministration Approvel of Oncology Drugs[J].J Clin Oncol.2003,21(7):1404 -1411.
[3]Kinnane N.Burden of bone disease[J].Eur J Oncol Nurs,2007,11(suppl 2):28-31.
[4]Chow E,Danjoux C,Connolly R,et al.Bone metastasis:review and critical analysis of random allocation trial of local field treatment:regarding Ratanatharathorn.Int J Radiat Oncol Biol Phys[J],2000,46(2):517-518.
[5]Conroy T,L Malissard,Dartois D.et al.Natural history and development of bone metastasis.Apropos of 429 cases[J].Bull Cancer,1998,75(9):845-857.
[6]Kong W,Zhang-Salomons J,Hanna TP,et al.A population-based study of the fractionation of palliative radiotherapy for bone metastasis in Ontario[J].Int J Radiat Oncol Biol Phys,2007,69(4):1209-1217.
[7]Fukutomi M,Yokota M,Chuman 14,et al.Increased incidence of bone metastases in hepatocellular carcinoma[J].Eur J Gastroenterol Hepatol,2001,13(9):1083-1088.
[8]肖亚景,苏敏,杨健,等.肝癌骨转移的特点及核素骨显像的价值[J].放射学践,2004.19(9):682-684.
[9]Koom WS,Seong JS,Lee M J,et al.Radiation therapy for bone metastasis from hepatocellular carcinoma[J].Taehan Kan Hakhoe Chi,2002,8(3):304-311.
[10]Kodama H,Aikata H,Uka K,et al.Efficacy of percutaneous cementoplasty for bone metastasis from hepatocellular carcinoma[J].Oncology,2007,72(5-6):285-292.
[11]中国抗癌协会肝癌专业委员会.原发性肝癌的临床诊断与分期标准[J].中华肝脏病杂志,2001,9(6)324.
[12]但汉雷,赵燕,张亚历,等.细针活检确诊以骨转移为首发表现的疑难性肝细胞癌(附2例报告)[J].第一军医大学学报,2002,22(11):978-980.
[13]Melichar B,Voboril Z,Toupková M,et al.Hepatocellular carcinoma presenting with bone metastasis[J]. J Exp Clin Cancer Res ,2002,21(3): 433-436.
[14] Albers I, Hartmann H, Bircher J, et al. Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis[J]. Scand J Gastroenterol, 1989,24(3): 269-276.
[15] Wilkie D, Loverjoy N, Dodd M, et al. Cancer pain intensity measurement:
concurrent validity of three tools - fignger dynamometer, pain intensity number scale , visual analogue scal [J] .Hosp J ,1990 ,6 (1) :1.
[16] Ciray I, Astrom G, Andreasson I, et al. Evaluation of new sclerotic bone
metastases in breast cancer patients during treatment [J]. Acta Radiol, 2000 ; 41 (2) : 178.
[17] Suto Y, Iwamiya T, Tanigawa N, et al. Clinical experience of 123I-IMP scintigraphy in detecting vertebral bone metastases of hepatocellular carcinoma. A comparison with bone scintigraphy with 99mTc-MDP[J]. Acta Radiol ,1994,35(2): 159-163.
[18] Okazaki N,Yoshino M,Yoshida T, et al. Bone metastasis in hepatocellular carcinoma [J]. Cancer ,1985,55(9): 1991-1994.
[19] Sato M, Ishida H, Konno K et al. Peripheral bone metastasis from hepatocellular carcinoma: sonographic findings[J]. Abdom Imaging ,2001, 26(5): 524-528.
[20] Otsuka N, Fukunaga M, Morita K, et al. Photon-deficient finding in sternum on bone scintigraphy in patients with malignant disease[J]. Radiat Med ,1990,8(5): 168-172.
[21] Body JJ.Breast cancer: bisphosphonate therapy for metastatic bone disease [J]. Clin Cancer Res, 2006 Oct 15;12(20 Pt 2):6258-6263.
[22] Seratini AN. Therapy of metastatic bone pain [J].J Nucl Med ,2001,42(6):895 -906.
[23] Seong J, Koom WS, Park HC. Radiotherapy for painful bone metastases from hepatocellular carcinoma [J]. Liver Int 2005;25:261—265.
[24] Fontana T, Siciliano M, Franceschelli A, et al. An atypical bone metastasis of hepatocellular carcinoma: case report and review of the literature [J]. Clin Ter ,2004,155(10): 447-451.
[25] Toyoda H, Kumada T, Kiriyama S, et al. Changes in the characteristics and survival rate of hepatocellular carcinoma from 1976 to 2000.,Analysis of 1365patients in a single institution in Japan[J].Cancer 2004;100:2415-2421.
[26]Ratanatharathorn V,Powers WE,Moss WT,et al.Bone Metastases:review and critical analysis of random allocation trials of local field treatment[J].Int J Radiat Oncol Biol Phys,1999,44(1):1-18.
[27]Kaizu T,Karasawa K,Tanaka Y,et al.Radiotherapy for osseous metastases from hepatocellular carcinoma:a retrospective study of 57 patients.[J]Am J Gastroenterol,1998,93(11):2167-2171.
[28]Seong J,Koom WS,Park HC.Radiotherapy for painful bone metastases from hepatocellular carcinoma[J].Liver Int 2005;25:261-265.
[29]Goblirsch MJ,Zwolak PP,Clohisy DR.Biology of bone cancer pain.Clin Cancer Res 2006;12:6231s-6235s.
[30]Suganuma T,Terauchi R,Shikina A,et al.A case of hepatocellular carcinoma with bone metastasis responding to concurrent TS-1/low-dose cisplatin(CDDP) therapy and radiotherapy[J].Gan To Kagaku Ryoho,2004,31(5):781-784.
[31]何健,曾昭沖,汤钊猷.原发性肝癌骨转移的相关预后因素分析及放疗效[J].中华放射肿瘤学杂志,2005,14(6):479.
[32]Rades D,Rudat V,Veninga T,et al.Prognostic factors for functional outcome and survival after reirradiation for in-field recurrences of metastatic spinal cord compression[J].Cancer 2008;113(5):1090-1096.
[33]Otsuka N,Fukunaga M,Morita K,et al.Photon-deficient finding in sternum on bone scintigraphy in patients with malignant disease[J].Radiat Med,1990,8(5):168-172.
[34]Dallari R,Gazzotti GL,Barozzini P,et al.Bone metastasis as a sign of the existence of latent neoplasia[J].Minerva Med,1986,77(22-23):981-987.
[35]Drago,J.R.Diagnostic techniques in prostatic cancer[J].Postgrad Med,1986,80(1):214-217,220,222-224.
[36]Farmer KD,Gellett LR,Vivian GC,Franklin K.Bladder diverticulum simulating a pelvic metastasis on a Tc-99m HDP bone scan[J].Clin Nucl Med,2001,26(1 ):60-61.
[37]Reddi AH,Roodman D,Freeman C,Mohla S.Mechanisms of tumor metastasis to the bone: challenges and opportunities [J]. J Bone Miner Res, 2003,18(2): 190-194.
[38] Kageyama Y, Kihara K, Kamata S, et al. Relationship between pretreatment serum levels of prostate specific antigen and bone metastasis in prostate cancer [J]. Hinyokika Kiyo ,1996,42(3): 197-199.
[39] Xu J, Wang R, Xie ZH, et al. Prostate cancer metastasis: role of the host microenvironment in promoting epithelial to mesenchymal transition and increased bone and adrenal gland metastasis [J]. Prostate ,1996,66(15): 1664-1673.
[40] Imai K, Suzuki T, Shimizu T, et al. Analysis of survival of prostate cancer patients in Japan and the USA [J]. Adv Exp Med Biol, 1992,324: 29-38.
[41] Knerr K, Ackermann K, Neidhart T, Pyerin W. Bone metastasis: Osteoblasts affect growth and adhesion regulons in prostate tumor cells and provoke osteomimicry [J]. Int J Cancer, 2004,111(1): 152-159.
[42] Cheville JC, Tindall D, Boelter C, et al. Metastatic prostate carcinoma to bone: clinical and pathologic features associated with cancer-specific survival [J]. Cancer, 2002, 95(5): 1028-1036.
[43] Carlinfante G, Vassiliou D, Svensson O, et al. Differential expression of osteopontin and bone sialoprotein in bone metastasis of breast and prostate carcinoma [J]. Clin Exp Metastasis , 2003,20(5): 437-444.
[44] El Otmany A, Bouklata S, Hafid H, et al. Bone metastasis revealing a primary prostate cancer [J]. J Radiol, 2000,81(9): 990-991.
[45] Katakami, N. Lung cancer with bone metastasis [J]. Gan To Kagaku Ryoho, 2006,33(8): 1049-1053.
[46] Ryo H, Sakai H.Bone metastasis of primary lung cancer [J]. Nihon Kokyuki Gakkai Zasshi, 1998,36(4): 317-322.
[47] 林学德,张晶.肺癌骨转移的临床特点分[J].中国肿瘤临床与康复,2000,7(5):38
[48] Koizumi M, Takahashi S, Ogata E. Comparison of serum bone resorption markers in the diagnosis of skeletal metastasis [J]. Anticancer Res , 2003,23(5b): 4095-4099.
[49] Sugiura H, Yamada K, Sugiura T, et al. Predictors of survival in patients with bone metastasis of lung cancer [J]. Clin Orthop Relat Res , 2008,466(3): 729-736.
[50]要洁,张湘茹.非小细胞肺癌骨转移的临床特点分析[J].实用癌症杂志,2004,19(4):392.
[51]周静,陈绪元,杨万毅,陈晓品.放疗联合化疗对60例肺癌骨转移的疗效分析[J].重庆医学,2007,36(7):634-635.
[52]Tsuya A,Fukuoka M.Bone metastases in lung cancer[J].Clin Calcium,2008,18(4):455-459.
[53]Hatano T,Suzuki K,Nagashima A,et al.Radiation therapy for bone metastasis from renal cell carcinoma with emphasis on local control[J].Hinyokika Kiyo,2007,53(10):687-690.
[54]Méndez López JM,García Mas R,Salvà Coll G.Metastasis of an adenocarcinoma of the colon to the 1st metacarpal bone[J].Ann Chir Main Memb,1997,Super 16(2):134-137.
[55]Weber KL,Doucet M,Price JE.Renal cell carcinoma bone metastasis:epidermal growth factor receptor targeting[J].Clin Orthop Relat Res,2003,(415 Suppl):S86-94.
[56]Sagoh M,Kodaki K,Ichikizaiki K,et al.Skull base metastasis from renal cell carcinoma presenting as abducens nerve paresis:report of two cases[J].No Shinkei Geka,1996,24:729.
[57]Seaman E,Goluboff ET,Ross S,et al.Association of radionuclide bone scan and serumalkaline phosphatase in patients with metastatic renal cell carcinoma[J].Urology,1996,48:692.
[58]Nakano S,Hasegawa Y,Ibuka K,et al.Survey for primary tumor site in patients with initial clinical presentation of bone metastasis[J].Kaku Igaku,1993,30(9):1049-1054.
[59]Weber KL,Pathak S,Multani AS,et al.Characterization of a renal cell carcinoma cell line derived from a human bone metastasis and establishment of an experimental nude mouse model[J].J Urol,2002,168(2):774-779.
[60]Inberg MV,Laurén P,Vuori J,Viikari SJ.Prognosis in intestinal-type and diffuse gastric carcinoma with special reference to the effect of the stromal reaction[J].Acta Chir Scand,1973,139(3):273-278.
[61]Etoh T,Baba H,Taketomi A,et al.Diffuse bone metastasis with hematologic disorders from gastric cancer:clinicopathological features and prognosis[J].Oncol Rep,1999,6(3):601-605.
[62]Yoshikawa K,Kitaoka H.Bone metastasis of gastric cancer[J].Jpn J Surg,1983,13(3):173-176.
[63]Nishidoi H,Koga S.Clinicopathological study of gastric cancer with bone metastasis[J].Gan To Kagaku Ryoho,1987,14(5 Pt 2):1717-1722.
[64]谢昌辉,王江桥,陈羽中.胃癌骨转移相关因素探讨[J].河南医科大学学报,1997,32(4):53.
[65]荣维淇,吴健雄眉癌骨转移的诊断与综合治疗[J].中国骨肿瘤骨病,2003.2(2):83-87.
[66]Sudo H,Takagi Y,Katayanagi S,et al.Bone metastasis of gastric cancer[J].Gan To Kagaku Ryoho,2006,33(8):1058-1060.
[67]Etoh T,Baba H,Taketomi A,et al.Sequential methothrextate and 5-fruororacil therapy for diffuse bone metastasis from gastric cancer[J].Anticancer Res,1998,18(3B):2085-2088.
[68]Hironaka SI,Boku N,Ohtsu A,et al.Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with bone metastasis[J].Gastric Cancer,2000,3(1):19-23.
[69]Coleman RE,Fogelman I,Habibollahi F,et al.Selection of patients with breast cancer for routine follow-up bone scans[J].Clin Oncol(R Coll Radiol),1990,2(6):328-332.
[70]Yu J J,Brennan M,Christos P,et al.Bone marrow micrometastases and adjuvant treatment of breast cancer[J].Breast J,2004,10(3):181-185.
[71]王跃珍,孙晓江,刘林林,等.208例乳腺癌骨转移相关因素分析[J].中国实验诊断学,2004,(04)406-407.
[72]朱旭生,莫耀薄,邹德环.乳腺癌术后核素全身骨显像临床价值[J]中华核医学杂志,2000,20(4):155.
[73]张武,高琦,张玲,等.多项肿瘤标志物对肿瘤敏感性的实测统计[J].放射免疫学杂志,2001.14(6):355-356.
[74]Bares,R.Skeletal scintigraphy in breast cancer management[J].Q J Nucl Med,1998,42(1):43-48.
[75]Kinne,DW.Staging and follow-up of breast cancer patients[J].Cancer,1990,67(4Suppl):1196-1198.
[76]吴昊,邵志敏,沈坤炜,等.乳腺癌骨转移相关的临床病理因素的研究[J].中国癌症杂志,2003,13(4):316-318.
[77]Kunkler IH,Merrick MV,Rodger A.Bone scintigraphy in breast cancer:A nine-year follow-up[J].Clinical Radiology.1985,36(3):279-282.
[78]邓豪余;段华新;邱娟.乳腺癌患者腋窝淋巴结转移与骨转移关系分析[J].湖南医科大学学报.2001,26(3):269-270.
[79]Holland R,Connolly JL,Gelman R,et al.The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast[J].J Clin Oncol,1990,8(1):113-118.
[80]龙启明,胡锐,申晓敏,等.乳腺癌骨转移106例临床分析[J].中国普外基础与临床杂志.2004,11(1):11-12.
[81]Vincent-Salomon A,Bidard FC,Pierga JY.Bone marrow micrometastasis in breast cancer:review of detection methods,prognostic impact and biological issues[J].J Clin Pathol,2008,61(5):570-576.
[82]刘宝善,主编.大肠肛门肿瘤学[M].第1版.成都:四川科学技术出版社,1998.464-465.
[83]张莉华,谢文晖,俞志昌.1500例肺癌患者核素骨显像结果分析[J].中华核医学杂志,1999,19:627.
[84]刘放,丁秀杰,张菁茹,等.大肠癌骨转移191例临床分析[J].中华普通外科杂志.2001.16(6).354-355.
[1]陈晓钟.骨转移瘤的临床研究进展,中国肿瘤杂志[J],2006,15(3):135-139.
[2]曹来宾,王安明,徐爱德等.1047例骨转移瘤的影像学诊断[J].中华放射肿瘤学杂志,1997,3l(8):547-551.
[3]骆红蕾,陈凡.骨转移癌放射治疗的疗效观察[J].中华放射肿瘤学杂志,2004,13(4):318.
[4]李小平,陈震,黄雯霞等.36例原发性肝癌合并骨转移的治疗[J].中国肿瘤临床,2003,30(3):220-221.
[5]苏锡龙.65例骨转移癌放射止痛瘤效果分析[J].中华放射肿瘤学杂志,2003,12(2):135.
[6]肖必文.胃癌术后36例骨转移[J].中国肿瘤临床,2002,9(7):471-473.
[7]余子豪.骨转移癌放射治疗进展[J].中国骨肿瘤骨病,2002,1(1):13-14.
[8]李云海,陆雪官,潘自强等.45例前列腺癌临床分析[J].中华放射肿瘤学杂志,2002,11(1):23-26.
[9]Clain A.Secondary malignant disease of bone[J].Br J Cancer,1965,19:15-29.
[10]Bilsky MH,Shannon FJ,Sheppard AS,et al.Diagnosis and management of a metastatic tumor in the atlantoaxia]spine.Spine,2002,27:1062-1069.
[11]徐万鹏.骨转移瘤的诊断与治疗[A].张天泽,徐光炜.肿瘤学(下册)[M].天津:天津科学技术出版社,1996.2580-2581.
[12]Coleman RE.Skeletal complications ofmalignancy[J].Cancer,1997,80(Ssuppl):1558-1594
[13]John R.Johnson,Grant Williams,et al.End Points and United States Food and Drug Administration Approvelof Oncology Drugs.J Clin Oncol,21:1404-1411.
[14]Kinnane N.Burden of hone disease.Eur J Oncol Nurs,207,11 suppl 2:S28-31
[15]Higinbotham NL,Marcove RC.The management of pathological fractures[J].J Trauma,1965,5(6):792- 798.
[16]陈宏远,谭毅等.基质细胞衍生因子-1及其受体CXCR4在肿瘤转移中的作用[J].生物医学工程杂志,2007,24(5):1180-1183.
[17] Koo BH, Oh D, Chung SY, et al. Deficiency of von Willebrand factor-cleaving protease activity in the plasma of malignant patients [J]. Thromb Res, 2002,105 (6): 471- 476.
[18] Bailey JM, Singh PK, Hollingsworth MA. Cancer metastasis facilitated by developmental pathways: Sonic hedgehog, Notch, and bone morphogenic, proteins [J]. J Cell Biochem, 2007, 102 (4): 829-839.
[19] Dittmar T , Heyder C, Gloria-Maercker E, et al. Adhesion molecules and chemokines: the navigat ion system for circulating tumor (stem) cells to metastasize in an organ-specific manner [J]. Clin Exp Metastasis, 2008, 25 (1): 11- 32.
[20] Wai PY, Kuo PC. Osteopont in: regulation in tumor metastasis [J].Cancer Metastasis Rev, 2008, 27 (1):103- 118.
[21] Yang S, Du J, Wang Z, et al. BMP-6 promotes E-cadherin expression through repressing deltaEFl in breast cancer cells [J]. BMC Cancer,2007, 7 (1): 211- 213.
[22] Harvey JR, Mellor P, EldalyH, et al. Inhibition of CXCR4-mediated breast cancer metastasis: a potential role for heparinoids [J ].Clin Cancer Res, 2007, 13 (5): 1562- 1570.
[23] Liang Z, Wu H, Reddy S, et al. Blockade of invasion and metastasis of breast cancer cells via targeting CXCR4 with an artificial microRNA[J]. Biochem Biophys Res Commun, 2007, 363 (3) : 542- 546.
[24] Liao J , McCauley LK. Skeletal metastasis: Established and emerging roles of parathyroid hormone related protein (PTH rP) [J]. Cancer Metastasis Rev, 2006, 25 (4) : 559- 571.
[25] Elena N , Sandra A , Tiffiney R, et al. HEF1-Dependent Aurora A Activation Induces Disassembly of the Primary Cilium [J]. Cell,2007, 129 (7) : 1351- 1363.
[26] Curtis CD, Likhite VS, McLeod IX, et al. Interaction of the tumor metastasis suppressor nonmetastatic protein 23 homologue H1 and estrogen receptor alpha alters estrogen-responsive gene expression [J].Cancer Res, 2007, 67 (21) : 10600- 10607.
[27] Van Sant C, Wang G, Anderson MG, et al. Endothelin signaling in osteoblasts: global genome view and implication of the calcineurin/NFAT pathway [J]. Mol Cancer Ther, 2007,6(1): 253 -261.
[28]Guise TA,Kozlow WM,Heras-Herzig A,et al.Molecular mecharisna of breast cancer metastases Clin Breast Cancer,2005 Suppl 2:S46-53
[29]Li Y,Cozzi PJ.Targeting uPA/uPAR in prostate cancer[J].Cancer Treat Rev,2007,33(6):521 -527.
[30]潘颂华.转移性骨肿瘤影像学诊断和治疗进展,上海医学影像,2008,17(2):174-177
[31]Rybak LD,Rosent hal DI.Radiological imaging for diagnosis of bone metastases.Q J Nucl Med,2001,45(3):53-64.
[32]Algra PR,Bloem JL,Tissing H,et al.Detection of vertebral metastases:Comparison between magnetic resonance imaging and bone scintigraphy[J].Radiographics,1991,11:219.
[33]Rosenbaum SJ,Lind W,Antoch G,et al.False- positive FDG- PET uptake- the role of PET/CT[J].Eur Radiol,2005,17:1
[34]田嘉禾主编.PET、PET/CT诊断学.北京:化学工业出版社医学出版分社,2007,368.
[35]曹海燕,刘露,何国城.血清Ⅰ CTP在前列腺癌骨转移诊断和疗效观察中的应用[J],中国医药导报2007,4(11):101-102.
[36]Lin A,RayM E.Targeted and systemic radio therapy in the treatment of bone metastasis[J].Cancer Metastasis Rev,2006,25(4):669-673.
[37]Ricco AI,Wodajo FM,Malawer M.Metastatic Carcinoma of the Long Bones[J].Am Fam Physician,2007,76(10):1489- 1494.
[38]傅深,陆嘉德.前列腺癌骨骼转移的治疗策略[J].中国癌症杂志,2007,17(3):213- 219.
[39]杨全成,徐勇.前列腺癌骨转移的治疗进展[J].国际泌尿系统杂志,2004,24(2):153-157.
[40]Williams&W ilk ins,OsborneCK.Adjuvant endocrine therapy[A].In:Harris,Lippman,Morrow,et al.Eds.Diseases of the breast[M].3rd Ed.USA.Lippincot:2004:865- 891.
[41]Rosen LS,Gordon DH,Dugan WJ,et al.Zoledronic acid is superior to pamidronate for the treatment of bone metastases in breast.carcinoma patients with at least one osteolytic lesion[J].Cancer,2004,100(1):36- 43.
[42]Saad F,Karakiewicz P,Perrotte P.The role of bispho sphonates in hormone- refractory prostate cancer[J].World J Urol,2005,23(1):14- 18.
[43]WHO.Medical need for opioid analgesics.Achieving balance in national opiooids control policy;Guidelinnes for Asessment Geneva:WHO Publication,2000,3-4.
[44]邹萍,蔡宗萍.~(153)Sm-EDTMP治疗1024例骨转移癌疗效分析[J].重庆医学,2005.34(8):1140-1141.
[45]Wang RF,Zhang CL,Zhu SL,et al.Comparative study of ~(153)Sm -EDTMP with pamidronate disodium in the treatment of patients with painful metastatic bone cancer[J].Med Princ Pract(MPP),2003,12(2):97-101.
[46]Zgiammarile F,Mognetti T,Resche I,eta].Bone pain palliation with 89Sr in cancer patients with bone metastases[J].Q J Nucl Med,2001,45(1):78- 83.
[47]刘继中,王臻等.骨转移癌的外科治疗[J],中国肿瘤临床.2001,28(8):579-584
[48]邓钢,何仕诚等.经皮椎体成形术治疗脊柱恶性肿瘤[J].介入放射学杂志,2005.14(3):261-264.
[49]王振堂,林琳,赫强等.椎体成形术的临床应用[J].中华放射学杂志,2004,38(12):1301-1303.
[50]Barnes EA,Parliament M,Henson J,et al.Palliative radiotherapy for patients with bone metastases[J[.Radiother Oncol,2003,67:221- 223.
[51]Milker-Eabel S,Eabel A,Thilman C,et al.Clinical results of retreatment of vertebral bone metasteses by stereotastic conformal radiotherapy and intensity-modulated radiotherapy[J].Int J Radiat Oncol Biol Phys,2003,55(1):162- 167.
[52]钟立松,张仟仕,赵雷等.常规分割与大分割放射治疗转移性骨痛患者的疗效观察[J].四川肿瘤防治,2005,18(3):187-188.
[53]Hoskin PJ,Ford HT,Harmer CL.Hemibody irradiation(HBI) for metastatic bone pain in two histologically distinct groups of patients[J].Clin Oncol(R Coll Radiol).1989,1(2):67-69.
[54]aiewald,M.,et al.Rapid course radiation therapy vs.more standard treatment:a randomized trial for bone metastases[J].Int J Radiat Oncol Biol Phys,1996.36(5):1085-1089.
[55]谭榜宪,周业琴,柳弥.116例骨转移癌放射治疗止痛效果分析[J].肿瘤学杂志,2003,9(6):332-333.
1 Nakashima T,Okuda K,Kojiro M,et al.Pathology of hepatocellular carcinoma in japan.232 Consecutive cases autopsied in ten years.Cancer,1983,51:863-877.
2 中国抗癌协会肝癌专业委员会.原发性肝癌的临床诊断与分期标准.中华肝脏病杂志,2001,9:324.
3 Asahara T,Dohi K,Hino H,et al.A case of HCC with bone metastasis responding to radiotherapy after successful hepatectomy of primary lesion.Hiroshima J Med Sci,1999,48:35-39.
4 Healey JH,Brown HK.Complications of bone metastases.Cancer,2000,88 Suppl 12:2940-2951.
5 Imamura H,Masutani S,Tatsuta M,et al.A case report of successful transcatheter arterial embolization therapy for osseous metastasis of HCC.Gan To Kagaku Ryoho,2000,27:1941-1946.
6 Seratini AN.Therapy of metastatic bone pain.J Nucl Med,2001,42:895-906.
7 Ratanatharathorn V,Powers WE,Moss WT,et al.Bone metastasis:review and critical analysis random allocation trials of local field treatment.Int J Radiat Oncol Biol Phys,1999,44:1-8.
8 Janjan N.Bone metastasis:Approaches to management.Semi Oncol,2001,28(4 Suppl 11):28-34.
9 Nielsen OS,Munro AJ,Tannock IF.Bone metastases:pathophysiology and management policy.J Clin Oncol,1991,9:509-524.
10 Rasmusson B,Vejborg I,Jensen AB,et al.Irradiation of bone metastases in breast cancer patients:a randomized study with 1 year follow up.Radiother Oncol,1995,34:179-184.
11 Coleman RE,Rubens RD.Bone Metastases.In:Martin DA,James OA,Allen SL,et al eds.Clinical Oncology.2nd ed.Livingstone:Harcourt Asia Churchill,2001.852.
12 陈允清.56例骨转移癌的放疗止痛效果分析.中华放射肿瘤学杂志,2000,9:234.
13 Buchali K,Correnes HJ,Schuerer M,et al.Results of a double blind study of 89-strontium therapy of skeletal metastases of prostatic carcinoma.Eur J Nucl Med,1988,14:349-351.
14 Laing AH,Ackery DM,Bayly RJ,et al.Strontium-89 chloride for pain palliation in prostatic skeletal malignancy.Br J Radiol,1991,64:816-822.
15 冯勤富,姑息性放射治疗.见:殷蔚伯,谷铣之,主编.肿瘤放射治疗学(第三版).北京:中国协和医科大学出版社,2002.1088-1090.
16 Rose C,Kagan R.The final report of the expert panel for the radiation oncology bone metastasis work group of the American College of Radiology.Int J Radial Oncol Biol Phys,1998,40:1117-11124.
17 Iwata M,Kaneko S,Terasaki S,et al.Importance of achieving complete necrosis during the first treatment for HCC to prevent bone metastasis:a prospective study.J Gastroenterol Hepatol,2001,16:46-51.
18 Fan ST,Ng IO,Poon RT,et al.Hepatectomy for Hepatocellular carcinoma:the surgeo's role in long-term survival.Arch Surg,1999,134:1124-1130.